Independent Member Advocate - Hybrid; Medfield, MA

Summary

As an Independent Member Advocate, you will be the first point of contact for our clients’ employees providing concierge service support via phone and emails.

• Manage a high volume of incoming calls and emails explaining healthcare plan benefits, assisting members with locating in-network physicians/facilities, educating members on available self-help resources, and maintaining 90% or above answered calls.
• Make outbound calls to provide eligibility/benefit information to healthcare service providers and advocate for members with health-care providers, pharmacies, and insurance carriers to resolve problems quickly and efficiently.
• Respond to basic inquiries on Flex Spending Accounts/Commuter Benefits, ancillary benefits, COBRA, and Medicare, and troubleshoot debit card declines and online portal access.
• Identify eligibility or claim errors and collaborate with other departments for correction to ensure a seamless member experience.
• Review book of business prior to renewal to revise client/member contact sheets and renewal materials, including Benefits Guide, benefit summaries, and medical funding sheets in conjunction with built plans.
• Verify eligibility and benefits for healthcare providers and handle inquiries regarding claim payments and remittances.
• Document call and email interactions according to standard procedure.
• Respond to incoming email inquiries efficiently and timely with follow-ups according to standard procedure.
• Escalate complex issues to higher-level representatives when necessary.
• Build and retain relationships with plan members and clients.
• Maintain a CSAT score of 3 or higher on phone surveys.

• High school diploma or equivalent.
• Basic customer service skills with a friendly, professional demeanor.
• Strong communication and interpersonal skills.
• Willingness to learn and adapt to new processes.
• Ability to thrive in a fast-paced environment.
• Reliability, punctuality, and the ability to manage time efficiently while handling multiple duties at once.

• 6 months to 2 years of customer service experience in group benefits (2 years preferred).
• Knowledge of healthcare benefits and the ability to communicate information to members.
• Proficient in Microsoft Outlook, Word, Excel, and PowerPoint.

Base pay: $28-$32 per hour. Additional variable compensation, commission, and/or annual bonus may be earned based on individual performance and company performance. Eligible employees receive health, wellbeing, retirement, and other financial benefits; paid time off, overtime pay for non-exempt employees; and robust learning and development programs. Job-related expenses are reimbursed per company policy and employees may receive perks and discounts.

One Digital is an equal opportunity employer. One Digital provides equal employment opportunities to all employees and applicants for employment regardless of veteran status, uniformed service member status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship or immigration status, physical or mental disability, genetic information, or any other category protected by federal, state, or local law.

Pursuant to local Fair Chance Ordinances, we will consider qualified applications with arrest or conviction records for employment.